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(5) In residential schools or other establishments for children and adolescents,
immunisation has special advantages. If it is adopted, it should be pursued on
a definite plan and should be applied to all entrants after the written consent of
the parents or guardians has been obtained. A Medical Officer should be designated
to carry out the work and should be responsible for keeping full records
of the immunisations and of the subsequent diphtheria history of the residents
and of the institutions in such a manner as to render them useful for statistical
purposes.
(6) Enquiries are sometimes received from medical practitioners who desire
to obtain experience of the technique employed in Schick testing and immunisation.
The Medical Officer of Health of the County or County Borough concerned
is usually able to make the necessary arrangements, and applications should,
in the first instance, be made to him. In cases of difficulty, enquiry should be
made in writing of the Senior Medical Officer, Med. I. Ministry of Health.
(7) It should be added, to prevent misconception, that immunisation is
not a way of dealing with an individual attack of diphtheria or with the ' 'carrier''
condition. Unlike the passive immunity produced by diphtheria antitoxin
which is immediate but transient, active immunity requires several weeks or
months for its full development, but endures for years and perhaps throughout
life.
II.
Recommendations on the practice of active immunisation of children susceptible to
diphtheria.
(This statement has been prepared in the Ministry of Health and accords
with the findings of the conference of experts from different countries held
in London in June, 1931, under the auspices of the Health Committee of
the League of Nations.)
(1) Among children in this country a proportion which varies in different
communities, but may be as high as 90 percent. or as low as 10 percent., is
susceptible to diphtheria. In order definitely to ascertain whether a child ia
susceptible or not, a preliminary (Schick) test should be made. This consists of
an injection into the superficial layers of the skin (intradermally) of a forearm
of 0.2 c.c. of standardised diluted diphtheria toxin (Schick Test Toxin). For
control purposes a second and precisely similar injection is made into the skin
of the other forearm but with toxin which has been previously rendered inactive
(Schick Control).
(2) At the same sitting a third injection is given, also intradermally into
the skin of the forearm, of a very small dose of formal toxoid (0.2 c.c. of a
1/100—1/200 dilution) with a view to determining whether there is any hypersensitiveness
which requires to be taken into consideration if immunisation is
to be proceeded with as a result of the Schick test.
(3) If the Schick reaction when read on or after the third day proves to be
negative the child, if over one year old, can for all practical purposes be
considered naturally immune to diphtheria.
(4) If the Schick reaction is positive, as indicated by the appearance of a
flush of ½ in. to 1 in. or more in diameter (which may not appear until the third
day), lasting for some days and gradually fading into a brown discoloration,
the child should be artificially immunised. The observer should have the
necessary experience in reading the results of the test and should record the
diameter of the reaction.
(5) The method of immunisation should be modified in accordance with the
reaction to the small dose of formol toxoid which constituted the third injection.
If there is no local response to this within 24/48 hours, or if there is a local